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Human Immunodeficiency Virus Infection in Pregnancy Epidemiology and Prevention of Vertical Transmission

Published online by Cambridge University Press:  02 January 2015

Donald E. Craven ,
Kathleen A. Steger  and
Cecelia Jarek
Donald E. Craven*
Affiliation:
Department of Medicine, Boston University School of Medicine, Division of Infectious Diseases, Thorndike Memorial Laboratory and Maxwell Finland Laboratory for Infectious Diseases, Boston, Massachusetts
Kathleen A. Steger
Affiliation:
Department of Medicine, Boston University School of Medicine, Division of Infectious Diseases, Thorndike Memorial Laboratory and Maxwell Finland Laboratory for Infectious Diseases, Boston, Massachusetts
Cecelia Jarek
Affiliation:
Department of Obstetrics, Boston University School of Medicine, Division of Infectious Diseases, Thorndike Memorial Laboratory and Maxwell Finland Laboratory for Infectious Diseases, Boston City Hospital, Boston, Massachusetts
*
Thorndike Building #303, Boston City Hospital, 818 Harrison Ave., Boston, MA 02118
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Extract

More than one million persons in the United States are infected with human immunodeficiency virus type 1 (HIV), and as of March 1993, approximately 12% of the 250,000 cases of acquired immunodeficiency syndrome (AIDS) reported to the Centers for Disease Control and Prevention (CDC) were women. Worldwide, it is estimated that more than 10 million persons are infected with HIV, and by the year 2000, most of the more than 40 million HIV-infected persons will be women and children. These data, along with the impact on individual women, underscore the importance of directed education and prevention programs. Early education and recognition of HIV infection in pregnant women will increase the opportunity for informed reproductive choices and preventive measures that may decrease vertical transmission. This article reviews the epidemiology of perinatal transmission and discusses strategies to interrupt transmission of HIV during pregnancy and the postpartum period. Information on the risk of HIV acquisition among healthcare workers and their ability to transmit HIV to patients also is reviewed.

Type
Review
Information
Infection Control & Hospital Epidemiology , Volume 15 , Issue 1 , January 1994 , pp. 36 - 47
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994 

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References

1. Massachusetts Department of Public Health. Update: AIDS in New England. AIDS Newsletter 1992;8.Google Scholar
2. Massachusetts Department of Public Health summary: monthly update. AIDS Surveillance Report. March 1993:1–3.Google Scholar
3. AIDS in women-United States. MMWR 1990;39:848–849.Google Scholar
4. Guinan, ME, Hardy, A. Epidemiology of AIDS in women in the United States: 1981 through 1986 . JAMA 1987;257:2039–2042.10.1001/jama.1987.03390150055033CrossRefGoogle ScholarPubMed
5. Ellerbrock, TV, Rogers, M. Epidemiology of human immunodeh ciency virus infection in women in the United States. Obstet Gynecol Clin North Am 1990;17:523–544.CrossRefGoogle Scholar
6. Mann, J. AIDS in the World. Cambridge, MA: University Press; 1992.Google Scholar
7. Iandesman, S, Minkoff, H, Holman, S, McCalla, S, Sijin, O. Serosurvey of human immunodeficiency virus infection in parturients: implications for human immunodeficiency virus testing programs of pregnant women. JAMA 1987;258:2701–2703.CrossRefGoogle Scholar
8. Chin, J. Current and future dimensions of the HIV/AIDS pandemic in women and children. Lancet 1990;336:221–224.CrossRefGoogle Scholar
9. Centers for Disease Control and Prevention. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR 1992;41:RR-17:1–19.Google Scholar
10. Chu, SY, Buehler, JW, Berkelman, RL. Impact of the human immunodeficiency virus epidemic on mortality in women of reproductive age, United States. JAMA 1990;264:225–229.10.1001/jama.1990.03450020077030CrossRefGoogle ScholarPubMed
11. Donegan, SP, Steger, KA, Recia, L, et al. Seroprevalence of human immunodeficiency virus in patients at Boston City Hospital: implications for public health and obstetric practice. Am J Obstet Gynecol 1992;167:622–629.CrossRefGoogle Scholar
12. Courgnaud, V, Laure, F, Brassard, A, et al. Frequent and early in utero HIV-I infection. AIDS Res Hum Retroviruses 1991;7:337–341.10.1089/aid.1991.7.337CrossRefGoogle Scholar
13. Eitelbach, F, Jimenez, E, Huang, Z, et al. HIV antigens can be demonstrated immunohistochemically in Formalin-fixed material from therapeutic abortions of HIV exposed pregnancies. Presented at the Fifth International Conference on AIDS; June 11-16, 1989; Montreal. Abstract MBP 18.Google Scholar
14. Jovaisas, E, Koch, MA, Schaeffer, A, et al. LAV/HTLV-III in a 20-week fetus. Lancet 1985;2:1129. Letter.CrossRefGoogle Scholar
15. Scott, GB, Fischi, MA, Klimas, N, et al. Mothers of infants with acquired immunodeficiency syndrome. JAMA 1985;253:363–366.CrossRefGoogle ScholarPubMed
16. Goedert, JJ, Mendez, H, Drummond, JE, et al. Mother to infant transmission of human immunodeficiency virus type 1: association with prematurity or low anti-gp120. Lancet 1989;2:1351–1354.10.1016/S0140-6736(89)91965-XCrossRefGoogle ScholarPubMed
17. Halsey, NA, Boulos, R, Holt, E, et al. Transmission of HIV-1 infection from mothers to infants in Haiti. Impact on childhood mortality and malnutrition. The CDS/JHU AIDS Project Team. JAMA 1990;264:2088–2092.CrossRefGoogle ScholarPubMed
18. Hira, SK, Kamanga, J, Bhat, GJ, et al. Perinatal transmission of HIV-1 in Zambia. BMJ 1989;299:1250–1252.CrossRefGoogle ScholarPubMed
19. Ryder, RW, Nsa, W, Hassig, SE. et al. Perinatal transmission of the human immunodeficiencyvirus type 1 to infants of seropositive women in Zaire. N Engl J Med 1989;320:1637–1642.CrossRefGoogle Scholar
20. European Collaborative Study. Mother-tochild transmission of HIV infection. Lancet 1988;2:1039–1043.Google Scholar
21. European Collaborative Study Group. Risk factors for mother-to-child transmission of HIV-1. Lancet 1992;339:1007–1012.CrossRefGoogle Scholar
22. Scott, GB, Mastrucci, MT, Hutto, SC, Parks, WP Mothers of infants with HIV infection: outcome of subsequent pregnancies. Presented at the Third International Conference on AIDS; June 1- 5.1987; Washington, DC. Abstract THP.91.Google Scholar
23. Blanche, SB, Rouzioux, C, Guihard-Moscato, ML, et al. A prospective study of infants born to women seropositive for human immunodeficiency virus type 1. N Engl J Med 1989;320:1643–1648.10.1056/NEJM198906223202502CrossRefGoogle ScholarPubMed
24. Gallo, RC. Human retroviruses: a decade of discovery and link with human disease. J Infect Dis 1991;164:235–243.CrossRefGoogle ScholarPubMed
25. Fauci, AS, Schnittman, SM, Poli, G. et al. Immunopathogenic mechanisms in human immunodeficiency virus (HIV) infection. Ann Intern Med 1991;114:678–693.CrossRefGoogle ScholarPubMed
26. Goedert, JJ, Duliege, AM, Amos, CI, Feiton, S, Biggar, RJ, The International Registry of HIV-Exposed Twins. High risk of HIV-1 infection for first-born twins. Lancet 1991;338:1471–1475.CrossRefGoogle ScholarPubMed
27. De Martino, M, Tovo, PA, Galli, L, et al. HIV-I infection in perinatally exposed siblings and twins. The Italian register for HIV infection in children. Arch Dis Child 1991;66:1235–1238.10.1136/adc.66.10.1235CrossRefGoogle ScholarPubMed
28. St. Louis, ME, Kamenga, M, Brown, C, et al. Risk for perinatal EHV-transmission according to maternal immunologic, virologe, and placental factors. JAMA 1993;269:2853–2859.CrossRefGoogle Scholar
29. Gallo, RC, Salahuddin, SZ, Popovic, M, et al. Frequent detection and isolation of cytopathic retroviruses (HTLV-III) from patients with AIDS and at risk for AIDS. Science 1984;224:500–503.10.1126/science.6200936CrossRefGoogle ScholarPubMed
30. Barre-Sinoussi, E, Montagnier, L, Dauguet, C, et al. Isolation of a Tlymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS). Science 1983;220:868–870.10.1126/science.6189183CrossRefGoogle ScholarPubMed
31. Johnson, VA. New developments in antiretroviral drug therapy for HIV infection. In: Volberding, P, Jacobson, MA, eds. AIDS Clinical Review 1992. New York. NY: Marcel Dekker Inc: 1992:69–104.Google Scholar
32. Fauci, AS. The human immunodeficiency virus: infectivity and mechanisms of pathogenesis. Science 1988;239:617–622.10.1126/science.3277274CrossRefGoogle ScholarPubMed
33. Levy, JA. Changing concepts in HIV infection: challenges for the 1990s. AIDS 1990;4:1051–1058.CrossRefGoogle ScholarPubMed
34. Gold, JWM. HIV-1 infection: diagnosis and management. Med Clin North Am 1992;76:1–18.CrossRefGoogle ScholarPubMed
35. Pantaleo, G, Graziosi, C, Demarest, JF, et al. HIV infection is active and progressive in lymphoid tissue during the clinically latent stage of disease. Nature 1993;362:355–358.CrossRefGoogle ScholarPubMed
36. Pantaleo, G, Graziosi, C, Fauci, AS. Immunopathogenesis of HIV infection. N Engl J Med 1993;328:327–335.Google Scholar
37. Zaaiier, HL. Exel-Oehlers, PV. Kraaiieveed, T. Altena, E. Lehe, PN. Early detection of antibodies to” HIV-1 by third-generation assays. Lancet 1992;340:770–772.Google Scholar
38. WHO. AIDS: Proposed WHO criteria for interpreting Western blot assays for HIV-1, HIV-P, and HTLV-I/HTLV-II. Bull World Health Organ 1991;69:127–130.Google Scholar
39. Schechter, MT, Ballern, PJ, Buskard, NA, et al. An anonymous seroprevalence survey of HIV infection among pregnant women in British Columbia and the Yukon Territory. Can Med Assoc J 1990;143:1187–1192.Google ScholarPubMed
40. Pitt, J. Perinatal human immunodeficiency virus infection. Clin Perinatol 1991;18:227–239.CrossRefGoogle ScholarPubMed
41. Burgard, M, Mayaux, M-J, Blanche, S, et al. The use of viral culture and p24 antigen testing to diagnose human immunodeficiency virus infection in neonates. N Engl J Med 1992;327:1192–1197.CrossRefGoogle ScholarPubMed
42. Bollinger, RC Jr, Kline, RL, Francis, HL, Moss, MW, Bartlett, JG, Quinn, TC. Acid dissociation increases the sensitivity of p24 antigen detection for the evaluation of antiviral therapy and disease progression in asymptomatic human immunodeficiency virus-infected persons. J Infect Dis 1992;165:913–916.10.1093/infdis/165.5.913CrossRefGoogle ScholarPubMed
43. Quinn, TC, Kline, R. Moss, MW, Livingston, RA, Hutton, N. Acid dissociation of immune complexes improves diagnostic utility of p24 antigen detection in perinatally acquired HIV-1 infection. N Engl J Med. In press.Google Scholar
44. Miles, SA, Balden, E, Magpantay, L, et al. Rapid serologic testing with immunecomplex-dissociated HIV p24 antigen for early detection of HIV infection in neonates. N Engl J Med 1993;328:297–302.CrossRefGoogle ScholarPubMed
45. Rogers, ME Ou, C-Y, Kilbourne, B, Schochetman, G. Advances and problems in the diagnosis of human immunodeficiency virus infection in infants. Pediatr Infect Dis J 1991:10:523–531.CrossRefGoogle ScholarPubMed
46. Rouzioux, C, Burgard, M, Blanche, S, et al. “Quantitative PCR for the diagnosis of HIV-1 infection in newborns to seropositive mothers. In: Andrieu, J-M, ed. Viral Quantitation in HIV Infection. Paris, France: John Libbey Eurotext; 1991:187–191.Google Scholar
47. Krivine, A, Firtion, G. Cao, L, Francoual, C, Hem-ion, R, Lebon, P. HIV replication during the first weeks of life. Lancet 1992;339:1187–1189.CrossRefGoogle ScholarPubMed
48. Ou, C-Y, Kwok, S, Mitchell, SW. DNA amplifications for direct detection of HIV-1 in DNA of peripheral blood mononuclear cells. Science 1988;239:295–297.CrossRefGoogle ScholarPubMed
49. Rogers, ME Ou, CY, Raytield, M, et al. Use of the polymerase chain reaction for early detection of the proviral sequences of human immunodeficiency virus in infants born to seropositive mothers. New York Citv Collaborative Studv of Maternal HIV Transmission and Montefiore Medical Center HIV Perinatal Transmission Study Group. N Engl J Med 1989;320:1649–1654.CrossRefGoogle Scholar
50. Comeau, AM. Hsu, H-W. Schwerzler, M. Mushinskv, G. Gradv, GE Detection of EDV in specimens from newborn screening programs. N Engl J Med 1992;326:1703.Google Scholar
51. Weiblen, BJ, Lee, FK, Cooper, ER, et al. Early diagnosis of HIV infection in infants by detection of IgA HIV antibodies. Lancet 1990;335:988–990.CrossRefGoogle ScholarPubMed
52. Quinn, TC, Kline, R, Livingston, A, et al. An algorithm for the early diagnosis of perinatally-acquired HIV-1 infection using the IgA immunoblot assay and the modified p24 antigen assay. Presented at the International AIDS Conference; June 1-5,1993; Berlin, Germany. Abstract.Google Scholar
53. Coombs, RV, Collier, AC, Main, JP, et al. Plasma viraemia in human immunodeficiency virus infection. N Engl J Med 1989;321:1626–1630.CrossRefGoogle ScholarPubMed
54. Ho, DD, Moudgil, T, Alam, M. Quantitation of human immunodeficiency virus type 1 in the blood of infected persons. N Engl J Med 1989;321:1621–1625.CrossRefGoogle ScholarPubMed
55. Schnittman, SM, Greenhouse, JJ, Psallidopoulos, MC, et al. Increasing viral burden in CD4+ T cells from patients with human immunodeficiency virus (HIV) infection reflects rapidly progressive immunosuppression and clinical disease. Ann Intern Med 1990;113:438–443.CrossRefGoogle ScholarPubMed
56. Clark, SJ, Saag, MS, Decker, WD, et al. High titers of cytopathic virus in plasma of patients with symptomatic primary HIV-1 infection. N Engl J Med 1991;324:954–960.CrossRefGoogle ScholarPubMed
57. Daar, ES, Mougdil, T, Meyer, RD, Ho, DD. Transient high levels of viremia in patients with primary human immunodeficiency virus type 1 infection. N J Med 1991;324:961–964.CrossRefGoogle ScholarPubMed
58. Biggar, RJ, Pahwa, S, Minkoff, H, et al. Immunosuppression in pregnant women infected with human immunodeficiencyvirus. Am J Obstet Gynecol 1989;161:1239–1244.CrossRefGoogle Scholar
59. Feinkind, L. Minkoff, HL. HIV in pregnancy. Clin Perinatol 1988;15:189–202.CrossRefGoogle ScholarPubMed
60. Coyne, BA, Landers, DV. The immunology of LUV disease and pregnancy and possible interactions. Obstet Gynecol Clin North Am 1990;17:595–606.CrossRefGoogle Scholar
61. Castilla, JA Rueda, R, Vargas, ML, et al. Decreased levels of circulating CD4 T during normal human pregnancy. J Reprod Immunol 1989;15:103–111.CrossRefGoogle ScholarPubMed
62. Selwyn, PA, Schoenbaum, EE, Davenny, K, et al. Prospective study of human immunodeficiency virus infection and pregnancy outcomes in intravenous drug users. JAMA 1989;261:1289–1294.CrossRefGoogle ScholarPubMed
63. Sunderland, A. Influence of human immunodeficiency virus infection on reproductive decisions. Obstet Gynecol Clin North Am 1990;17:585–594.CrossRefGoogle ScholarPubMed
64. Sunderland, A, Minkoff, H, Handte, J, Moroso, G, Iandesman, S. The impact of human immunodeficiency virus serostatus on reproductive decisions of women. Obstet Gynecol 1992;79:1027–1031.Google ScholarPubMed
65. James, ME. HIV seropositivity diagnosed during pregnancy: psychosocial characterization of patients and their adaptation. Gen Hosp Psychiatry 1988:10:309–316.CrossRefGoogle ScholarPubMed
66. Minkoff, HL. Care of pregnant women infected with human immunodeficiencyvirus. JAMA 1987;258:2714–2717.CrossRefGoogle Scholar
67. Chavkin, W. Mandatory treatment for drug use during pregnancy. JAMA 1991;266:1556–1561.10.1001/jama.1991.03470110102041CrossRefGoogle ScholarPubMed
68. Anastos, K, Palleja, S. Caring for women at risk of HIV infection. J Gen Intern Med 1991;6:S40–S46.10.1007/BF02599257CrossRefGoogle ScholarPubMed
69. Selwyn, PA. Feingold, A. Iezza, A. et al. Primary care for patients with human immunodeficiency virus infection in a methadone maintenance treatment program. Ann Intern Med 1989;111:761–763.CrossRefGoogle Scholar
70. Feingold, AR, Vermund, SH, Burk, RD, et al. Cervical cytologic abnormalities and papillomavirus in women infected with human immunodeficiency virus. J Acquir Immune Defic Syndr 1990;3:896–903.Google ScholarPubMed
71. Nanda, D. Human immunodeficiency virus infection in pregnancy. Obstet Gynecol Clin North Am 1990;17:617–626.CrossRefGoogle ScholarPubMed
72. Thiry, L, Sprecher-Goldberger, S, Jonckheer, T et al. Isolation of AIDS virus from cell free breast milk of three healthy virus carriers, Lancet 1985;2:891–892.CrossRefGoogle ScholarPubMed
73. Friedland, GH, Klein, RS. Transmission of the human immunodeficiency virus. N Engl J Med 1987;317:1125–1135.CrossRefGoogle ScholarPubMed
74. Ruff, A, Coberly, J, Burnley, A, et al. Prevalence of HIV in breastmilk. Presented at the Eighth International Conference on AIDS; July 19-24. 1992: Amsterdam. The Netherlands. Abstract C-1523.Google Scholar
75. Little, BB, Bawdon, RE, Christmas, JT, Sobhi, S, Gilstrap, LC III. Pharmacokinetics of azidothymidine during late pregnancy in Long-Evans rats. Am J Obstet Gynecol 1989;161:732–734.CrossRefGoogle ScholarPubMed
76. Lopez-Anaya, A, Unadkat, JD. Schumann, LA, Smith, AL. Pharmacokinetics of aidovudine (azidothymidine), I: transplacental transfer. J Acquir Immune Defic Syndr 1990;3:959–964.Google ScholarPubMed
77. Liebes, L, Mendoza, S, Wilson, D, Dancis, J. Transfer of zidovudine (AZT) by human placenta. J Infect Dis 1990;161:203–207.CrossRefGoogle ScholarPubMed
78. Lopez-Anaya, A, Unadkat, JD, Schumann, LA, Smith, AL. Pharmacokinetics of zidovudine (azidothymidine), III: effect of pregnancy. J Acquir Immune Defic Syndr 1991; 4:64–68.CrossRefGoogle ScholarPubMed
79. Pons, JC, Taburet, AM, Singlas, E, Delfraissy, JF, Papiernik, E. Placental passage of azathiothymidine (AZT) during the second trimester of pregnancy: study by direct fetal blood sampling under ultrasound. Eur J Obstet Gynecol Reprod Biol 1991:40:229–231.CrossRefGoogle ScholarPubMed
80. Richman, DD. Zidovudine resistance of human immunodeficiency virus. Rev Infect Dis 1990;12:S507–S512.CrossRefGoogle ScholarPubMed
81. Richman, DD, Grimes, JM, Lagakos, SW. Effect of stage of disease and drug dose on zidovudine susceptibilities of isolates of human immunodeficiency virus . J Acquir Immune Defic Syndr 1990;3:743–746.Google ScholarPubMed
82. Larder, BA, Darby, G, Richman, DD. HIV with reduced sensitivity to zidovudine (AZT) isolated during prolonged therapy. Science 1989:243:1731–1734.CrossRefGoogle ScholarPubMed
83. Larder, BA, Kellman, P, Kemp, SD. Zidovudine resistance predicted by direct detection of mutations in DNA from HIV-infected lymphocytes. AIDS 1991;5:137–144.CrossRefGoogle ScholarPubMed
84. Sperling, RS, Stratton, I? Treatment options for human immunodeficiency virus-infected pregnant women. Obstetric-Gvnecolonic Working Group of the AIDS Clinical Trials Group of the National Institute of Allergy and Infectious Diseases. Obstet Gynecol 1992;79:443–448.Google Scholar
85. Sperling, RS, Stratton, P, O'Sullivan, MJ, et al. A survey of zidovudine use in pregnant women with human immunodeficiency virus infection. NEngl J Med 1992;326:857–861.CrossRefGoogle ScholarPubMed
86. Dancis, J, Lee, JD. Mendoza, S, Liebes, L. Transfer and metabolism of dideoxynosine by the perfused human placenta. J Acquir Immune Defic Syndr 1993;6:2–6.Google Scholar
87. Zidovudine in Pregnancy Registry: International Interim Report, January I, 1989, through December 31,1991. Research Triangle Park, NC: Burroughs Wellcome Co; 1992.Google Scholar
88. Toltzis, P, Marx, CM, Kleinman, N, Levine, EM, Schmidt, EV. Zidovudine-associated embryonic toxicity in mice. J Infect Dis 1991;163:1212–1218.CrossRefGoogle ScholarPubMed
89. Lyman, WD, Tanaka, KE, Kress, Y, Rashbaum, WK, Rubinstein, A, Soeiro, R. Zidovudine concentrations in human fetal tissue: Implications for perinatal AIDS. Lancet 1990;335:1280–1281. Letter.CrossRefGoogle ScholarPubMed
90. Barzilai, A, Sperling, RS, Hyatt, AC, Wedgwood JE Reidenberg, BE, Hodes, DS. Mother to child transmission of human immunodeficiency virus 1 infection despite zidovudine therapy from 18 weeks of gestation. Adiatr Infect Dis J 1990;9:931–933.Google ScholarPubMed
91. Ukwu, HN. Graham, BS, Lambert, JS, Wright, PE Perinatal transmission of human immunodeficiency virus-1 infection and maternal immunization strategies for prevention. Obstet & Gynecol 1992;80:458–468.Google ScholarPubMed
92. Ugan, KE, Goedert, JJ, Boyer, J. Vertical transmission of human immunodeficiency virus (HIV) infection. Reactivity of maternal sera with glycoprotein 120 and 41 peptides from HIV type 1. J Clin Invest 1992;89:1923–1930.CrossRefGoogle Scholar
93. Rossi, P, Moschese, V. Mother-to-child transmission of human immunodeficiency virus. FASEB J 1991;5:2419–2426.CrossRefGoogle ScholarPubMed
94. Devash, Y, Calvelli, TA Wood, DG, Reagan, KJ, Rubinstein A Vertical transmission of HIV is correlated with the absence of high affinity-avidity maternal antibodies to the gp 120 principal neutralizing domain. Proc Natl Acad Science USA 1990;87:3445–3449.CrossRefGoogle Scholar
95. Rossi, P, Moschese, V, Lombardi, V, Broliden, PA, Wahren, B, Wigzell, H. HIV-1 mother-to-child transmission. Lancet 1990;1:359–360.CrossRefGoogle Scholar
96. Rossi, I! Moschese, V, Broliden, PA, et al. Presence of antibodies to HIV-1 gp 120 env epitopes correlates with the uninfected status of the children born to seropositive mothers. Proc Natl Acad Science USA 1989:86:8055–8058.CrossRefGoogle Scholar
97. Halsey, NA, Markham, R, Wahren, B, Boulos, R, Rossi, P, Wigzell, H. Lack of association between matemal antibodies to V3 loop peptides and maternal-infant HIV-1 transmission. J Acquir Immune Defic Syndr 1992;5:153–157.Google Scholar
98. Rubinstein, A, Sicklick, M, Gupta, A, et al. Acquired immunodeficiency with reversed T4/T8 ratios in infants bom to promiscuous and drug-addicted mothers. JAMA 1983;249:2350–2356.CrossRefGoogle Scholar
99. Parekh, BS, Shaffer, N, Pau, CP, et al. Lack of correlation between maternal antibodies to V3 loop peptides of gp120 and perinatal HIV-1 transmission. The NYC Perinatal HIV Transmission Collaborative Study, AIDS 1991;5:1179–1184.CrossRefGoogle ScholarPubMed
100. Daniel, MD, Kirchhoff, F, Czajak, SC, Sehgal, PK, Desrosiers, RC. Protective effects of a live attenuated SIV vaccine with a deletion in the nef gene. Science 1992;258:1938–1941.CrossRefGoogle ScholarPubMed
101. Henderson, DK, Saah, AJ, Zak, BJ, et al. Risk of nosocomial infection with human T-cell lymphotropic virus in a large cohort of intensively exposed healthcare workers. Ann Intern Med 1986;104:644–647.CrossRefGoogle Scholar
102. Gerberding, JL. Bryant-Leblanc, CE, Nelson, K, et al. Risk of transmitting the human immunodeficiency virus, cytomegalovirus and hepatitis B virus to healthcare workers exposed to patients with AIDS and AIDS-related conditions. J Infect Dis 1987;156:1–6.CrossRefGoogle Scholar
103. Centers for Disease Control. Update: Universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B and other blood-borne pathogens in health-care settings. MMWR 1988;37:377–388.Google Scholar
104. Marcus, R, The Cooperative Needlestick Surveillance Group. Occupational risk of AIDS among healthcare workers N Engl J Med 1988;319:1118–1122 CrossRefGoogle Scholar
105. Centers for Disease Control. Update: acquired immunodeficiency syndrome and human immunodeficiency virus among health-care workers. MMWR 1988;37:229–231.Google Scholar
106. Panfilio, A, Chamberland, M, Shapiro, C, et al. Human immunodeficiency virus serosurvey among hospital-based surgeons. Presented at the International AIDS Conference; June 610, 1993; Berlin, Germany. Abstract PO-Cl&3024.Google Scholar
107. Centers for Disease Control. Preliminary analysis: HIV serosurvey of orthopedic surgeons 1991. MMWR 1991;40:309–312.Google Scholar
108. Ciesielski, C, Marianos, D, Ou, C-Y, et al. Transmission of human immunodeficiency virus in a dental practice. Ann Intern Med 1992;116:798–805.CrossRefGoogle Scholar
109. Robert, L, Chamberland, M, Marcus, R, et al. HIV-infected healthcare workers (HCWs): lookback investigation update. Infect Control Hosp Epidemiol 1993;14:419. Abstract 32.Google Scholar
110. Chamberland, ME, Bell, DM. HIV transmission from healthcare worker to patient: What is the risk? Ann Intern Med 1992;116:871–872.CrossRefGoogle ScholarPubMed
111. Mishu, B, Schaffner, W, Horan, JM, et al. A surgeon with AIDS: lack of evidence of transmission to patients. JAMA 1990;264:467–470.CrossRefGoogle ScholarPubMed
112. Von Reyn, CF, Gilbert, TT, Shaw, FE, et al. Absence of HIV transmission from an infected orthopedic surgeon: a 13-year look-back study. JAMA 1993;269:1807–1811.CrossRefGoogle ScholarPubMed
113. Dickinson, GM, Morkart, RE, Kilmas, NG, et al. Absence of HIV transmission from an infected dentist to his patients: an epidemiologic and DNA sequence analysis. JAMA 1993;269.1802–1811.CrossRefGoogle ScholarPubMed
114. Porter, JD, Cruikshank, JG, Gentle, PH, et al. Management of patients treated by a surgeon with HIV infection. Lancet 1990;335:113–114.CrossRefGoogle ScholarPubMed
115. Sacks, JJ. AIDS in a surgeon. N Engl J Med 1985;313:1017.Google ScholarPubMed
116. Rogers, AS, Froggat, JW, Townsend, T, et al. Investigation of potential HIV transmission to the patients of an HIV-infected surgeon. JAMA 1993;269:1795–1801.CrossRefGoogle Scholar
117. Danila, RN,. MacDonald, K, Rhame, E, et al. Alook-back investigation of patients with HIV-infected physicians: public health implications. N Engl J Med 1991;325:1406–1411.CrossRefGoogle ScholarPubMed
118. Mishu, B, Schaffner, W. HIV-infected surgeons and dentists: Looking back and looking forward. JAMA 1993;269:1843–1844.CrossRefGoogle ScholarPubMed
119. American College of Obstetricians and Gynecologists (ACOG). Human immunodeficiency virus infections. ACOG Technical Bulletin 1992;169:1–11.Google Scholar
120. Friedland, GH, Saltzman, BR, Rogers, ME et al. Lack of transmission of HTLVIII/LAV infection to household contacts of patients with AIDS or ARC with oral candidiasis. N Engl I Med 1986;314:3444–3449.Google Scholar
121. Van de Perre, P, Simonon, A, Msellati, P, et al. Postnatal transmission of human immunodeficiency virus type 1 from mother to infant. A prospective cohort study in Kigali, Rwanda. N Engl J Med 1991;325:593–598.CrossRefGoogle ScholarPubMed
122. Van de Perre, P, Hitimana, DG, Simonon, A, et al. Postnatal transmission of HIV-1 associated with breast abscess. Lancet 1992;339:1490–1491.CrossRefGoogle ScholarPubMed
123. Hira, SK, Mangrola, UG, Mwale, C, Chintu, C, Tembo, G, Brady, WE, et al. Apparent vertical transmission of human immunodeficiency virus type 1 by breast-feeding in Zambia. J Adiatr 1990;117:421–424.Google ScholarPubMed
124. Palasanthiran, P, Ziegler, JB, Stewart, GJ, et al. Breast feeding during primary maternal human immunodeficiency virus infection and the risk of transmission from mother-to-infant. J Infect Dis 1993;167:441–444.10.1093/infdis/167.2.441CrossRefGoogle ScholarPubMed
125. Colebunders, R. Kapita, B, Nekwei, W, et al. Breastfeeding and transmission of HIV. Lancet 1988;2:1487.CrossRefGoogle ScholarPubMed
126. Zeigler, JB, Cooper, DA, Johnson, RO, et al. Postnatal transmission of AIDS-associated retrovirus from mother to infant. Lancet 1984;1:896–898.Google Scholar
127. Lederman, SA. Estimating infant mortality from human immunodeficiency virus and other causes in breast-feeding and bottle-feeding populations. Pediatrics 1992;89:290–296.CrossRefGoogle ScholarPubMed
128. Jelliffe, DB, Jelliffe, EFI? Postnatal transmission of HIV infection. N Engl J Med 1992;326:642–643.Google ScholarPubMed
129. Oxtoby, MJ. Human immunodeftciency virus and other viruses in human milk: placing the issue in broader perspective. Adiatr Infect Dis J 1988;7:825–835.CrossRefGoogle ScholarPubMed
130. Dunn, DT, Newell, ML, Ades, AE, Peckham, CS. Risk of human immunodeficiency virus type 1 transmission through breast feeding. Lancet 1992;340:585–587.CrossRefGoogle Scholar
131. Wilson, CB, Westall, J. Activation of neonatal and adult human macrophage by alpha, beta and gamma interferons. Infect Immun 1985;49:351–356.CrossRefGoogle ScholarPubMed
132. MacCallum, LR, France, AJ, Jones, ME, et al. The effects of pregnancy on the progression of HIV disease. Presented at the Fourth International Conference on AIDS; June 12-16, 1988; Stockholm, Sweden. Abstract 4032.Google Scholar
133. Wood, GW. Mononuclear phagocytes in the human placenta. Placenta 1980;1:113–115.CrossRefGoogle ScholarPubMed
134. Anonymous. Global programme on AIDS. Consensus statement from the WHO/UNICEF consultation on HIV transmission and breast-feeding. Weekly Epidemiology Record 1992;67:177–179.Google Scholar
135. American College of Obstetricians and Gynecologists. Prevention of HIV infection and AIDS. ACOG Committee Statement. 1987;1-8.Google Scholar
136. American Academy of Pediatrics and American College of Obstetricians and Gynecologists. Guidelines for farinata! Cure. 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 1988.Google Scholar
137. Hill, WC, Bolton, V, Carlson, JR. Isolation of acquired immunodeficiency syndrome virus from the placenta. Am J Obstet Gynecol 1987;157:10–11.CrossRefGoogle ScholarPubMed
138. Jauniaux, E, Nessmann, C, Imvert, C, et al. Morphological aspects of the placenta in HIV pregnancies. Placenta 1988;9:633–642.CrossRefGoogle ScholarPubMed
139. Chandwani, S, Greco, MA, Mittal, K, et al. Pathology and HIV expression in term placentas from seropositive women. Presented at the Fifth International Conference on AIDS; June 11-16, 1989; Montreal, Canada. Abstract MBP 20.Google Scholar
140. Main, EK, Aversa, C. Expression of CD4 genes in human placental cells: a new target for HIV infection? Am J Reprod Immunol 1987;17:134. Abstract.Google Scholar
141. Marion, RW, Wiznia, AA, Hutcheon, G, et al. Human T cell lymphotrophic virus type embryopathy: a new dysmorphia syndrome. Am J Dis Child 1986;140:638–640.CrossRefGoogle Scholar
142. Soiero, R, Rashbaune, WK, Rubinstein, A, et al. The incidence of human fetal HIV-1 infection as determined by the presence of HIV-1 DNA in abortus tissue. Presented at the Seventh International Conference on AIDS; June 1620, 1991; Florence, Italy. Abstract WC3250.Google Scholar
143. Peutherer, JF, Rebus, S, Aw, D, et al. Detection of HIV in the fetus: a study of six cases. In: Abstracts of the Fourth International Conference on AIDS. Stockholm, Sweden: Swedish Ministry of Health and Social Affairs, June 12-16, 1988. Abstract 7235.Google Scholar
144. Lapointe, N, Michaud, J, Pekovic, D, et al. Transplacental transmission of HTLV-III virus. N Engl J Med 1985;312:1325–1326.Google ScholarPubMed
145. Maury, W, Potts, BJ, Rabson, AB. HIV-1 infection of first trimester and term human placental tissue: a possible mode of maternal-fetal transmission. J Infect Dis 1989;160:583–588.CrossRefGoogle Scholar
146. DiMaria, H, Courpotin, C, Rouzious, C, et al. Transplacental transmission of human immunodeficiency virus. Lancet 1986;2:215–216.Google Scholar
147. Hanson, CG, Shearer, WT. Pediatric AIDS: diagnosis of HIV infection in infants and children. In: Feigin, RD, Cherry, JD, eds. Textbook of Pediatric Infectious Diseases. 3rd ed. Philadelphia, PA: W.B. Saunders Co. In press.Google Scholar
148. Vogt, MW, Wirt, DJ, Craven, DE, et al. Isolation patterns of the human immunodeficiency virus from cervical secretions during the menstrual cycle of women at risk for the acquired-immunodeficiency syndrome. Ann Intern Med 1987;106:380–382.CrossRefGoogle ScholarPubMed
149. Wofsy, CB, Padian, NS, Cohen, JB, Greenblatt, R, Coleman, R, Korvick, JA. Management of HIV disease in women. In: Volberding, R Jacobson, MA, eds. AIDS Clinical Review. New York, NY: Marcel Dekker Inc: 1992:303–321.Google Scholar
150. Pomerantz, RJ, De La Monte, SM, Donegan, SP, et al. Human immunodeficiency virus (HIV) infection of the uterine cervix. Ann Intern Med 1988;108:321–327.CrossRefGoogle ScholarPubMed
151. Kind, C, Brandle, B, Wyler, CA, et al. Epidemiology of vertically transmitted HIV-1 infection in Switzerland: results of a nationwide prospective study. Eur J Pediatr 1992;151:442–448.CrossRefGoogle ScholarPubMed
152. Hutto, C, Parks, WR Lai, SH, et al. A hospital-based prospective study of perinatal infection with human immunodeficiency virus type 1. J Pediatr 1991;118:347–353.CrossRefGoogle ScholarPubMed
153. David, FJ, Autran, B, Tran, HC, et al. Human trophoblast cells express CD4 and are permissive for productive infection with HIV-1. Clin Exp Immunol 1992;88:10–16.CrossRefGoogle ScholarPubMed
154. Lewis, SH, Kohler, CR, Fox, HE, et al. HIV-1 in trophoblastic and villous Hofbauer cells, and haematological precursors in eight-week fetuses. Lancet 1990;335:565.CrossRefGoogle ScholarPubMed